REFRACTORY STATUS EPILEPTICUS IN CHILDREN - ROLE OF CONTINUOUS DIAZEPAM INFUSION

To determine efficacy of continuous diazepam infusion in the treatment of refractory status epilepticus in a retrospective study, we analyze d data of 62 children admitted consecutively to our Pediatric Intensiv e Care Unit with a diagnosis of refractory status epilepticus. The uni t followed a standard treatment protocol for diazepam infusion; if it failed, thiopental infusion was used. The mean age of patients was 2.8 0 years (range, 1.5 to 11.5 yr). Thirty-six patients (60%) had acute i nfections of the central nervous system and 10 (16%) had idiopathic ep ilepsy. Diazepam infusion was used in 57 patients. This treatment cont rolled seizures in 86% of patients (49/57), on average within 40 minut es (median, 30 min; range, 10-120 min), at a mean infusion rate of 0.0 17 mg/kg/min (range, 0.01-0.03 mg/kg/min). The mean total duration of infusion was 68 hours (range, 12-220 hr). Diazepam infusion was associ ated with hypotension in one patient, respiratory depression requiring ventilatory support in 12% of patients (6/49), and death in 14% of pa tients (7/49). Thiopental infusion was used in nine patients, includin g eight in whom diazepam infusion had failed. Thiopental infusion cont rolled seizures in all nine patients, but all of them needed mechanica l ventilation, and seven needed vasopressor support for hypotension; f our patients (44%) died. We conclude that continuous diazepam infusion is a reasonably effective modality to control refractory status epile pticus in children and is associated with reduced need for ventilatory and vasopressor support.